Care1st Health Plan Jobs in Cupertino

Currently, there are no Care1st Health Plan jobs available in Cupertino, California. You may wish to explore jobs in nearby locations on the Care1st Health Plan jobs in California page or view related jobs below.
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GENERAL SUMMARY: The Manager of Operations for the Coordinated Care Initiative (CCI) plans, organizes, implements and evaluates the Company’s CCI Operations. The Manager is responsible for staffing and managing all departmental functions. Ensures effective cooperation and collaboration with other departments to implement and achieve organizational objectives and goals. Develops and implements pro...

GENERAL SUMMARY: The Senior Claims Examiner is responsible for analyzing and adjudicating medical claims. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or CSIM (Customer Service Inquiry Module). Identifies root causes of claims payment e...

GENERAL SUMMARY: The SIU Investigator, in accordance with established policies and procedures, is responsible for processing and performing day to day functions and operations of the SIU department. This includes, but not limited to, the investigation of cases involving complaints where a potential non-compliant incident and/or allegation or a violation of policies and guidelines has been committ...

GENERAL SUMMARY: Complex Case Management (CCM) is responsible for coordinating resources, researching appropriate cost-effective alternatives/options for the catastrophic, chronically ill, identified high-risk members on a case by case basis to achieve realistic outcomes. The primary goal of the CCM is to optimize member care in the ambulatory care setting to prevent/decrease emergency room visit...

GENERAL SUMMARY: The Manager of MLTSS & ICT Clinical Operations is responsible for ensuring the daily operations and compliance with established protocols as they pertain to clinical care coordination for SNP MOC care transitions, coordination of Managed Long Term Support Services and Inter-disciplinary Care Team meetings. This position reports to the Director of Medical Services and plays an int...